Gastroesophageal Reflux, as Measured By 24-Hour pH Monitoring, in 509 Healthy Infants Screened for Risk of Sudden Infant Death Syndrome

Abstract

Continuous long-term esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Because reflux to a limited extent is physiologic, the determination of optimal thresholds to separate normal from abnormal reflux is mandatory. Esophageal pH was measured during 24 hours in 509 healthy thriving infants, aged 3 days to 1 year, using a glass microelectrode with an external reference electrode connected to a portable recorder. Percentiles of the four parameters studied (reflux index or percent of the investigation time with a pH <4, number of episodes with a pH <4 during 24 hours, number of episodes lasting >5 minutes, the duration of the longest episode (in minutes)) are presented. A percentile curve of the reflux index regarding the age distribution shows that the normal range for the reflux index during the first 12 months of life is about 10% (95 percentile), decreasing from 13% at birth to 8% at 12 months. Application of an age-related percentile curve offers a close-to-reality possibility of data interpretation and illustrates that there is inevitably an overlap of data between normal and abnormal populations, because reflux is a phenomenon occurring to some extent in every human being.

Role of Gastroesophageal Reflux in Pediatric Upper Airway Disorders

“…Gastroesophageal reflux (GER) is a common physiologic occurrence in neonates and infants that decreases during the first year of life 1 . The classic symptoms of pathologic pediatric GER are emesis, dysphagia, burping, choking, gagging, and failure to thrive.…”

Missing the Distal-most [Z6] Impedance Channel? The Study Can Be Salvaged!

“…Our rescue approach allows the clinician to derive meaningful information from the tracing without the need to subject the patient to further invasive testing. With the defective tracing featured in this article, we found (in a 4-month-old baby boy) that while the acid reflux index and total number pH probe-detected acid events (pH < 4) were in the normal range for infants (1.5% and 41, respectively), 2 impedance data showed that greater than 80% of both acid (pH < 4, 20/24) and non-acid (pH ≥ 4, 28/33) reflux events reached the proximal esophagus (Z1 and/or Z2) and symptoms of cough were positively associated with both acid (pH < 4) (symptom association probability = 96.5%) and non-acid (pH ≥ 4) (symptom association probability = 100%) GER.…”

Gastroesophageal Reflux: A Critical Factor in Pediatric Subglottic Stenosis

“…At this time, no normative data exist for the pharyngeal probe in children. Vandenplas et al 8 placed singlechannel pH probes in 509 healthy infants as part of a screening program for sudden infant death syndrome. They found that the reflux pattern in children older than 12 months resembled that of adults.…”